08.18 - Obstructive, Restrictive Dz (Nichols) - Questions Flashcards Preview

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Flashcards in 08.18 - Obstructive, Restrictive Dz (Nichols) - Questions Deck (78):
1

Bronchiectasis: Obstructive or Restrictive?

Obstructive

2

Pneumoconiosis: Obstructive or Restrictive?

Restrictive

3

Sarcoidosis: Obstructive or Restrictive?

Restrictive

4

4 types of Non-infectious interstitial lung disease

Usual Interstitial Pneumonia; Crytogenic Organizing Pneumonia; Nonspecific Interstitial Pneumonia; Radiation Pneumonitis

5

3 cytokines involved in pathogenesis of emphysema

IL-8, TNF, and LeukotrieneB4

6

What causes pulmonary HTN in emphysema

Decr pulmonary vascular capacitance --> Same blood thru smaller vessels --> Incr pulmonary arterial pressure

7

Pulmonary arterial pressure in Emphysema

Increased --> Cor Pulmonale

8

Emphysema due to smoking is usually ___-acinar

Centri-

9

Type of emphysema in young male smokers with spontaneous pneumothorax

Distal Acinar

10

Most typical symptom of pure emphysema

Insidious onset of progressive dyspnea

11

Mucus hypersecretion thought to be mediated by what cytokine and incr transcription of what gene

IL-13; MUC5AC

12

From where do the cytokines originate that cause mucus hypersecretion in CB

T Cells --> IL-13

13

Symptom of CB

Productive Cough

14

Distinctive, defining feature of CB

Bronchial hypersecretion of mucus

15

Bronchiectasis is permanent dilation of bronchi due to ____ by ___

destruction of muscle and elastic tissue by necrotizing infection

16

3 underlying states leading to infection causing Bronchiectasis

(1) CF; (2) Immunodeficiency; (3) Kartagener Syndrome

17

What is Kartaganer Syndrome

Ciliary impairment

18

Localized bronchiectasis can occur

distal to a bronchial tumor or from necrotizing pneumonia

19

Symptoms of Bronchiectasis

Chronic persistent cough productive of copious purulent sputum

20

Signs of Bronchiectasis

Expiratory Rhonchi

21

Early acute phase asthma

IgE, Mast Cells, Histamine, Leukotriene B4, Vagus Nerve

22

Late Acute Phase Asthma

Eosinophils, Neutrophils, Lymphs, IL-1, TNF, IL-6, Leukotrienes C4, D4, E4, PGD2, PAF

23

Asthma exhibits ___-type inflammation

TH2-type

24

Three C's of Asthma

Curschmann's Spirals; Charcot-Leyden Crystals; Creola Bodies

25

Curschmann's Spirals

Small whorled mucus strands

26

Creola Bodies

Fragments of degenerated sloughed respiratory epithelium

27

Presence of goblet cells in bronchioles

Not normally present --> Appear in Asthma

28

Pneumoconioses

Fibrosing restrictive lung diseases caused by inhalation of particles

29

Fibrosing restrictive lung diseases caused by inhalation of particles

Pneumoconioses

30

Coal Worker's: Activation of __ and __ production leads to fibrosis

Activation of Inflammasome and IL-1 production

31

What percent of Coal Worker's results in progressive massive fibrosis

Less than 10%

32

Most prevalent chronic occupational disease in the world

Silicosis

33

Ingestion of Silica by alveolar macrophages leads to release of

TNF, IL-1, Fibronectin, ROS, and TGF-B --> Fibrosing chronic inflammation

34

Gross pathology of Silicosis

Discrete, palpable grey-tan nodules w/ or w/out anthracotic pigment

35

Microscopic pathology of Silicosis

Nodules of concentrically arranged hyalinized collagen

36

Tissue response to asbestos

Coated with iron and elicit fibrosis

37

Signs of Asbestosis

Basal pulmonary crackles

38

Symptoms of Asbestosis

Dyspnea and persistent dry cough

39

4 most common sites of sarcoidosis

Lung, Lymph Node, Eye, Skin

40

Sarcoid: stimuli cause ___ response, mediated by ___

TH1 CD4 response, mediated by IL2, IFN-g, and TNF-A

41

Role of IL-8 in Sarcoid

attract neutrophils

42

Sarcoid: IL-4 mediates

later transition to fibrosing inflammation; chemoattractant to fibroblasts

43

later transition to fibrosing inflammation; chemoattractant to fibroblasts

IL-4

44

Type of granulomas in Sarcoidosis

Non-caseating; Non-necrotic; Tight naked

45

Pulmonary signs of Sarcoidosis

Usually none

46

Classic CXR of Sarcoidosis

Reticulonodular pulmonary infiltrates and bilateral hilar lymphadenopathy

47

Reticulonodular pulmonary infiltrates and bilateral hilar lymphadenopathy

Sarcoidosis, Histoplasmosis, Tuberculosis

48

Distribution of granulomas in Sarcoidosis

Lympharangitic distribution along bronchovascular bundles and in bilateral hilar lymph nodes

49

Symptoms and Signs of UIP/IPF

Insidious onset of dyspnea; Pulmonary crackles

50

Gross pathology of UIP/IPF

Large discrete scars, making lung firmer and more gray than usual; Visceral pleura has nodularity

51

Microscopic Hallmark of UIP/IPF

Fibroblast foci of immature fibrosis bulging into alveoli from interstitium

52

Definitive dx of UIP/IPF is made by

lung biopsy

53

Treatment of UIP/IPF

Transplantation

54

Why is it important to differentiate UIP from COP and NSIP

COP and NSIP respond to steroid therapy

55

Epidemiology of COP

Late middle age non-smokers

56

Histologic Hallmark of COP

Masson Bodies: Plugs of fibrosing granulation tissue in the alveoli

57

Masson Bodies

Plugs of fibrosing granulation tissue in the alveoli: COP

58

Symptoms and Signs of COP

Present with cough, sometimes productive; Dry inspiratory crackles

59

CXR of COP

Ground Glass Bilateral Opacities

60

Tx of COP

Steroids

61

Epidemiology of NSIP

Middle age women non-smokers

62

Presentation of NSIP

Dyspnea and Cough

63

CXR of NSIP

Bilateral Ground Glass Opacities

64

Microscopic features of Radiation Pneumonitis

Atypical Type 2 Pneumocyte Hyperplasia and blood vessel injury

65

Young male smoker with spontaneous pneumothorax

Distal Acinar Emphysema

66

Top relevant Interleukin in Asthma vs COPD

IL-5; IL-8

67

Charcot-Leyden crystals are composed of

Galectin-10

68

UIP is usually due to

Genetically-determined aberrant healing from aspiration of gastric contents, smoking, exposure to toxins

69

Temporality of UIP

Heterogenous

70

Lobar location of UIP

Worse in peripheral lower lobes

71

UIP genetic predisposition in many patients

TERT or TERC genes

72

Fibroblast Foci

Histologic Hallmark of UIP

73

Masson Bodies are found in

COP

74

Temporality of NSIP vs UIP

Homogenous vs Heterogenous

75

Number of infections/injuries in NSIP, UIP, COP

1 in NSIP and COP; repeated in UIP

76

Patients with Silicosis are more prone to __ due to ___

Tuberculosis, paralyzed macrophages

77

Tight, well-formed, non-caseating granulomas

Sarcoidosis

78

Caseating Granulomas =

Tuberculosis